Imagine a healthy, active woman in her early 40s, who has run 28 marathons and has absolutely no family history of heart disease or other risk factors, suddenly having a heart attack. For Betsy Kinkead of Minneapolis, she doesn’t have to imagine it — it was her. After personally experiencing a heart attack with no apparent cause not just once, but twice, she said her “life has changed forever.”
Betsy’s first heart attack happened in 2014 at age 43, when she went out for a run after volunteering in her oldest daughter’s kindergarten class. She was about seven miles into her run around Lakes Calhoun and Harriet when, she explained, “Literally, out of nowhere, this extremely strange chest pressure hit me and stopped me in my tracks. I started walking and then my left hand went numb. I thought, ‘What in the world is going on? Am I having a heart attack?’ I’m like, ‘There is NO way I am having a heart attack.’”
SCAD: Striking a growing number of women in their 40s and 50s
Indeed, not only was Betsy experiencing a heart attack, but a particular type of heart attack called SCAD — spontaneous coronary artery dissection — that is striking a growing number of women in their 40s and 50s (perhaps due to improved diagnoses). SCAD is different from a typical heart attack in that there is a spontaneous tear in an artery that is apparently healthy. There are typically no pre-disposing risk factors for SCAD and the causes are uncertain, but more than 80 percent of known cases involve women. It can affect women as young as 20 and as old as 80, and is the #1 cause of heart attack among pregnant and postpartum women.
Like SCAD, heart conditions that afflict women are often different from those that affect men, and most of these conditions have not been adequately studied. That’s why the Minneapolis Heart Institute Foundation® (MHIF) is committed to advancing the understanding of heart disease in women, how to prevent it, and how to optimize patient care through its soon-to-be-launched Women’s Cardiovascular Science Center. For example, through a partnership with Cedars Sinai Medical Center, a team of MHIF researchers led by Dr. Elizabeth Grey have been conducting research on SCAD using data on more than 100 women with the condition. By exploring the treatment experiences of female SCAD patients, researchers hope to better understand the ideal treatment options for women who present with the condition.
Hesitant to “make a big deal out of it”
Betsy initially discounted the seriousness of her symptoms (as many women commonly do) and didn’t seek immediate treatment. She described the feeling in her chest not as pain, but pressure, comparing it to the feeling many people have when they drink a carbonated beverage and it “goes down the wrong pipe.” The feeling lasted longer, however, and was right in the middle of her chest. After unsuccessfully trying to reach her sister (a nurse), or her brother-in-law (a cardiologist), via phone, she reached her husband, who urged her to go to the hospital. But then the chest pressure subsided, so she just headed home, took a shower and ate a sandwich. Thankfully, however, after getting a call back from her brother-in-law, he persuaded her to go get things checked out. Still “not wanting to make a big deal out of it,” she opted not to go to the hospital but instead to urgent care, where testing revealed elevated levels of troponin, a protein released in the blood after a heart attack.
Knowing of the world-renowned reputation of the Minneapolis Heart Institute® (MHI) at Abbott Northwestern Hospital, Betsy insisted on being treated there and received care from Dr. Ivan Chavez and Dr. John Lesser, who are also MHIF research physicians. With SCAD, a conservative approach is typically followed. Because angiograms and stent insertion can cause further tearing of the artery, and because SCADs frequently heal on their own, the standard approach for care is often careful monitoring and treatment with certain medications such as baby aspirin, beta blockers and potentially a blood thinner. Because Betsy’s SCAD had caused her artery to completely collapse, a stent was inserted to reopen the artery and resume normal blood flow. One and half years later, when Betsy felt chest pressure again while simply walking home from a neighbor’s house, she knew the urgency of getting treatment and was fortunate that time that her tear did not require a stent.
With SCAD, “it’s a hard way to live”
Asked about the impact on her active lifestyle, Betsy said, “The problem is, they don’t know what causes SCAD and they don’t know if exercise makes it worse or not. So Dr. Lesser gave me some guidelines. I do still run, but wear a heart rate monitor and need to keep my heart rate below 155. I’m very, very careful about that and I always work out with my phone next to me, wear a medical alert bracelet and carry nitroglycerin pills.”
She tries not to worry, but explained, “It’s a hard way to live, because I could have another SCAD any time, or I could never have another one. One of the biggest challenges with SCAD is the mental part. It’s affecting mostly women with no history of heart disease who have typically been active and healthy and then — BAM! — they’ve had a heart attack. So it’s like living with a time bomb not knowing if you’ll have another heart attack at any time. Many SCAD patients suffer anxiety, depression and have frequent chest pains resulting in ER visits.”
Betsy herself finds support through a Facebook group with more than 2,800 SCAD survivors worldwide, which includes many women who recently had babies, and many who are very active, fit and otherwise healthy. She understands the desperate need for research into this condition and is glad it’s starting to get attention.
“I feel like now SCAD is all over the news, but four years ago, nobody had heard of it,” she said. “It’s getting more and more press and publicity, and that’s good, because they definitely need to figure out what’s happening. I’m thrilled that the MHIF is focusing some women’s heart disease research efforts on SCAD.”